Free air on plain film: Do we need a computed tomography too?

Solís, Carolina; Chang, Yuchiao; Moya, Marc A. de; Velmahos, George C.; Fagenholz, Peter J.

doi:10.4103/0974-2700.125631

Cited by 13 publications

(4 citation statements)

References 32 publications

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“…It is unclear if the results described herein would pertain to these patients. In a small study involving 25 patients with pneumoperitoneum on plain radiography by Solis et al, peritonitis was indicative of the need for operative intervention 41 . In addition, we excluded patients who did not receive a surgical consult as we believe that these patients were unlikely to have the opportunity for operative intervention.…”

Section: Discussionmentioning

confidence: 99%

Management of Pneumoperitoneum

et al. 2019

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Objectives: The aim of this study was to compare morbidity and mortality between nonoperative and operative treatment of pneumoperitoneum. Background: Pneumoperitoneum is a potentially life-threatening condition that has been traditionally treated with surgical intervention. Adequately powered studies comparing treatment outcomes are lacking. Methods: Chart review and computer-assisted abstraction were used to identify patients with pneumoperitoneum at 5 hospitals from 2010 to 2015. Patients with recent abdominal procedures or contained perforation were excluded. Patients were grouped by treatment modality: comfort measures only (CMO), nonoperative treatment, or operative intervention. CMO included only symptom-palliation, whereas nonoperative therapy included all interventions (antibiotics, peritoneal drains, resuscitation) excluding surgery. Outcomes were mortality, discharge disposition, and 30-day complications. Covariates included demographics, comorbidities, and acuity at presentation. Results: Forty patients received CMO, 202 underwent nonoperative treatment, and 199 underwent operative intervention. CMO patients had 98% 30-day mortality. There was no difference in 30-day (P ¼ 0.64) or 2-year mortality (P ¼ 0.53) between patients treated nonoperatively and operatively. Compared with patients treated operatively, patients treated nonoperatively were more likely to have a colorectal source of pneumoperitoneum (37% vs 31%; P ¼ 0.03). Using logistic regression, operative treatment was associated with increased dependence on enteral tube feeding or total parenteral nutrition [odds ratio (OR) 4.30, 95% confidence interval (CI), 1.99-9.29] and nonhome discharge (OR 3.61, 95% CI,). Among patients with clinical peritonitis, operative treatment was associated with reduced mortality (OR 0.17, 95% CI, 0.04-0.80). Conclusions: Operative intervention is associated with reduced mortality in patients with pneumoperitoneum and peritonitis. In the absence of peritonitis, operative treatment is associated with increased morbidity and nonhome discharge.

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Section: Discussionmentioning

confidence: 99%

Management of Pneumoperitoneum

et al. 2019

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“…47 Solis et al 38 showed in a small retrospective study that CT delays surgery in patients with pneumoperitoneum on abdominal radiograph. Thus, given the risk of unnecessary laparotomy and unnecessary delays in surgery where it is required, patients with strong clinical suspicion of GI perforation should ideally have a CT instead of Abdominal X-ray (AXR) as first line investigation (Figure 3).…”

Section: Gastrointestinal Perforationmentioning

confidence: 99%

“…37 It is usually identified as pneumoperitonem on an erect chest and/or abdominal radiograph. 38 Specific signs include Rigler sign, football sign and triangle sign. 31,39 Plain abdominal radiography is not accurate for pneumoperitoneum with studies on specificity ranging from 53% to 89.2%.39-42 False positive results can result in unnecessary laparotomy and needless exposure to general anaesthesia.…”

Section: Gastrointestinal Perforationmentioning

confidence: 99%

Will Plain Abdominal Radiographs become Obsolete?

Ismail¹,

Malik²

2017

Radiol Open J

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Citation ABSTRACTPlain abdominal radiographs are often used as the first line investigation in diagnosing abdominal pathologies such as bowel obstruction and gastrointestinal perforation. However, their interpretation can often be non-specific. Given the reduction in radiation doses in recent years, This article reviews the role of plain abdominal radiographs and other imaging modalities in bowel obstruction and gastrointestinal perforation.

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“…Plain abdominal radiography have a sensitivity of 53% to 89.2% compared with 86% to 100% when CT is used, but adding the CT will add a delay to the operation room. 12 The combination of a supine or decubitus radiographs with an erect chest film may be the only available modalities in hospitals with limited resources.…”

mentioning

confidence: 99%